Corticosteroids have the effect of raising blood glucose levels by disrupting the metabolism of carbohydrates
and the storage of adispose tissue/fat. A person undergoing chemotherapy with dexamethasone as a premed without accompanying type 2 diabetes will also experience raised blood sugars.
Dexamethasone is the more potent of the corticosteroids. It has a long half-life in the body (the time interval in which 1/2 of a drug metabolically clears thr body).
Oncologists tend to prescribe a routine dose of dexamethasone as a pre-med with little regard to individuality. Dexamethasone eases experienced symptoms of nausea, fatigue, muscle/joint pain that can accompany systemic chemotherapy. Dexamethasone has an “activating” and uplifting effect on most people. Given for a range of inflammatory medical conditions and body-on-body auto-immune conditions, most people feel “better” in a general sense when on corticosteroids.
Corticosteroids are not a benign medication, however. Taken on a long-term and/or high dose basis, detrimental secondary effects on the body are a given. Abrupt discontinuation should be avoided.
A wise rule of thumb for anyone on corticosteroids: Discuss and review with your prescribing physician (oncologist) and other specialists that provide for your care (gastroenterologist, primary care, other) the risk vs. benefit profile of the dose of corticosteroid being prescribed to you.
A 3 mg dose of dexamethasone, as an example, is a whopper of a dose.
Perhaps a lower dose of dexamethasone, say 1 mg, would be sufficient in the providing the desired/wanted effects (lessening nausea, fatigue) without the steep rise in blood sugar levels that you are experiencing?
Perhaps dosing with prednisolone or prednisone would be more favorable for you than dexamethasone? Prednisone, on a mg to mg comparison to dexamethasone, has a shorter half-life and will raise blood sugar at a less steep slope.
Corticosteroid-induced type 2 diabetes is not readily discussed but one possible consequence of long-term or high dosing of a glucocorticosteood. Glucocorticosteoids include the spectrum: hydrocortisone; prednisone; prednisolone; dexamethasone.
I do not profess to be an expert on glucocorticosteoids and wisely suggest that you share dialogue with your physician. I have been on corticosteroids, myself, for more than 20 years and am the poster child for both the amazing benefits and troubling adverse effects of steroids. Many of my most challenging health hurdles are linked in association to exogenous steroid consumption. I do not have a choice due to primary Addison’s. Steroids are a necessity for me to sustain life.
Knowledge is power. Talk with your prescribing provider to discuss the risk:benefit profile of your current pre-med dexamethasone dosing. Your quality of life after active treatment may be influenced by the steroids you take during treatment. Look to protect the highest quality of life possible.
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.